Rabies Pre-Exposure Prophylaxis: A Systematic Review on Safety, Immunogenicity and Booster Recommendations

Abstract

Rabies infection is a serious and fatal disease that disproportionately affects children and low socioeconomic groups. Pre-exposure prophylaxis (PrEP) is a preventive strategy to protect high-risk groups. Timely updating recommendations for rabies PrEP are needed, especially to meet the needs of the underserved population. This review aimed to find recent evidence available to evaluate the safety and immunogenicity of rabies PrEP of reduced dose and duration; intramuscular (IM) and intradermal (IM) administration; and to assess booster recommendations following rabies PrEP. The literature review was conducted according to PRISMA guidelines for systematic reviews and meta-analyses. A literature search of PubMed, Google Scholar and Scopus was performed from the database for studies in the past five years (1st Jan 2017-30th May 2021). Of 45 studies identified, 15 publications met the inclusion criteria for safety, dosage, immunogenicity and booster recommendations. Most studies identified that the recommended dose and duration is safe and immunogenic for children and adults. Rabies vaccine booster is indicated for occupational exposure. The current recommendation on rabies PrEP is safe for adults and children, and the immunogenicity is not inferior to the 1-dose 3-visit regime, with equivalent effectiveness via both routes (ID and IM).